The “Librarian’s Pick” is a regular section of the Review in which one of the International Committee of the Red Cross’s (ICRC) librarians picks and writes about their favourite new book relating to international humanitarian law, policy or action, which they recommend to the readers of the journal.
The ICRC Library welcomes researchers interested in international humanitarian law (IHL) and the institution’s work throughout the years. Its online catalogue is the gateway to the most recent scholarship on the subject, documents of diplomatic and international conferences, all ICRC publications, rare documents published between the founding of the ICRC and the end of the First World War, and a unique collection of military manuals. The Library Team also publishes research guides in order to help researchers access the full texts of the most relevant and reliable sources in the field of IHL and the ICRC, as well as a comprehensive IHL Bibliography, with three issues every year.
The online catalogue is available at: library.icrc.org. For more information on the research guides, see: blogs.icrc.org/cross-files/category/research-guide. To subscribe to the IHL Bibliography, email library@icrc.org with “IHL Bibliography subscription” in the subject line.
Mental suffering is everywhere in the ICRC Library’s collections. A library cannot collect testimonies, reports and scholarship on humanitarian law and action in armed conflict for 160 years without it piling up on the shelves and bleeding through the pages.
Yet, as a subject, mental health has remained relatively diffuse and implicit. In our catalogue, the dedicated keyword was only adopted in 2021 to replace the under-used “mental illness”, too narrow and clinical a term. There are related pre-existing keywords, such as “psychiatry”, “psychological tension” and “psychological support”. “Health” is a much-used descriptor, though it has unsurprisingly largely functioned as a shorthand for “physical health”. While mental suffering is omnipresent in the collection, it appears only rarely in catalogue descriptions. Perhaps past librarians, not unlike jurists, have grappled with naming and classifying something both so undoubtedly pervasive and apparently intangible as the mental harm caused by conflict.
For this reason, this “Librarian’s Pick” departs from our usual format: rather than highlighting a single new acquisition, we have chosen to take a step back and look across the ICRC Library’s collection as a whole. This thematic issue of the Review provides a timely opportunity to investigate the under-representation of “mental health” as a topic in our descriptions; the Library’s long history also allows us to look for patterns and evolutions in how the subject has been treated in the literature. In this piece, we trace in a few broad strokes how mental health has been named, understood and addressed over time in our collections. The piece is organized in five thematic sections that also largely follow a chronological progression, reflecting how the literature has focused on the mental health of different groups affected by armed conflict at different moments in time.
Mental health in war in the nineteenth and early twentieth centuries: Overlooked or hiding in plain sight?
The ICRC’s first concern was the physical health of sick and wounded combatants. In the nineteenth- and early twentieth-century medical treatises in the ICRC Library’s collection, treating visible injuries is very much the priority, on and off the battlefield. Relieving mental suffering is an afterthought; it is also a task better left to the nurse, whose “feminine qualities”, it is argued, make her naturally suited to bringing comfort to suffering soldiers.Footnote 1
Our earliest book with a clear focus on mental rather than physical health is French psychiatrist Jean Lépine’s Troubles mentaux de guerre (Mental Disorders of War), a 1917 manual for doctors treating First World War soldiers showing signs of trauma.Footnote 2 Published two years after “shell shock” entered the language of the war, Lépine’s manual was meant to provide doctors with guidance on treatments and on how to decide who could or could not be returned to the battlefield.Footnote 3 He prescribed arsenic, phosphorus and strychnine, and warned against the dangers of reading.Footnote 4 While the treatments then considered standard seem astounding today, they should not overshadow the text’s early recognition of the impact of war on soldiers’ mental health.
“Despair unspeakable and misery of every kind”Footnote 5
Not all forms of psychological suffering caused by conflict were initially overlooked. Relieving the pain of families searching for missing, detained or deceased loved ones is woven into the very DNA of the International Red Cross and Red Crescent Movement (the Movement). Already in his 1862 Memory of Solferino, Henry Dunant had promised a young dying soldier he would inform his father of his fate.Footnote 6 In the ICRC Library’s heritage collections, published lists of names of detained or deceased combatants make up a tangible paper trail of Movement actors’ work to relieve the psychological suffering of their families.Footnote 7
Providing answers was also at the heart of the mission of the ICRC’s first tracing agencies. During the Franco-Prussian War (1870–71), the Spanish Civil War (1936–39) and the two World Wars, these predecessors of the current Central Tracing Agency worked to account for the missing and reconnect people. The effort to relieve psychological suffering was explicit and intentional, not incidental, even if it was not framed in mental health-care terms. In 1870, the very first report of the Basel Agency noted that facilitating the exchange of thousands of letters between prisoners of the Franco-Prussian war and their families had dried many tears.Footnote 8
Barbed wire disease: The mental health of prisoners of war in the two World Wars
After the outbreak of the First World War, in addition to the tremendous work carried out by the International Prisoners of War Agency to keep track of the fate of captured soldiers, the ICRC negotiated with the belligerents to be allowed to visit the camps and monitor conditions of detention. These inspections, which were again carried out during the Second World War, put ICRC delegates in a unique position to witness the physical and psychological well-being of prisoners of war (PoWs) and civilian internees, and to advocate on their behalf.Footnote 9
In recent years, many historians have carried out research on wartime captivity in the ICRC Archives, delving into camp visit reports and correspondence.Footnote 10 Their work brings new understanding to attitudes towards mental health at the time and usefully complements historical documents found in the Library’s collection related to the work of the PoW agencies of the First and Second World Wars.Footnote 11
Published by the ICRC, National Red Cross and Red Crescent Societies (National Societies) or other charitable organizations, materials from this collection document the countless efforts to keep minds engaged and not to fall prey to hopelessness and despair. Strikingly, many initiatives were led by PoWs themselves.Footnote 12 At the beginning of the Second World War, the ICRC sought to assist these efforts through the creation of its Intellectual Relief Service. A 1943 report on relief for PoWs and civilian internees described the concern in these terms: “We are in duty bound, within the powers granted to us, to prevent any soldier from entirely sinking into a state where he loses all faith in himself.”Footnote 13
“The feeling of hopelessness and despair so terribly dangerous to the balance of a man’s mind in captivity”Footnote 14
A “melancholy state” is how Winston Churchill described the condition of PoWs,Footnote 15 while the French used the word cafard to describe a similarly melancholic state of mind.Footnote 16 However, these terms seem to describe a temporary condition that could affect any soldier rather than a distinct illness with potential long-lasting effects. After the First World War, Swiss physician Lukas Vischer sought to scientifically describe a medical condition known as “barbed wire disease”,Footnote 17 and others spoke of “gefangenitis”,Footnote 18 “psychastenia”Footnote 19 or “captivitose”.Footnote 20 While these evocative terms did spread awareness of the effect of long-term captivity on mental health, they suggest that medical understanding of these issues remained limited, with no consistent diagnosis. In spite of this, a sign that the seriousness of mental health issues was well understood can be found in bilateral treaties between belligerents regarding the internment in neutral countries of PoWs. “Barbed wire disease” was included in the list of serious medical conditions making prisoners eligible for internment in Switzerland in the 1917 Agreement between the British and German governments. The 1918 Agreement between the French and German governments mentions “psychasténie”, the term that will eventually be used in the Annex to 1929 Geneva Convention relative to the Treatment of Prisoners of War, marking one of the rare explicit expressions of concern for mental health in an international humanitarian law (IHL) treaty.Footnote 21
A closer look at the ICRC Library’s IHL collection: Mental harm in IHL treaties and their interpretation after the Second World War
In the thousands of scholarly books and articles that make up the ICRC Library’s IHL collection, we can only note the dearth of references to mental health. A search for IHL documents with the keyword “mental health” returns a mere nine references, all published since 2014. While librarian indexing practices could be at fault, it seems that in this case, IHL scholars are in agreement: the subject has only been tackled very recently, mainly through the prism of mental harm inflicted upon civilians. Locating earlier references to mental health requires a bit of creative thinking on the part of researchers. In the inter-war period, international law scholars discussed the psychological effects of bombardments on the civilian population, and whether a prohibition of aerial bombardment for the purpose of terrorizing the civilian population was warranted.Footnote 22 Nonetheless, demoralizing the civilian population was seen as a legitimate objective of military strategy, and millions living in urban centres were subjected to repeated air raids during the Second World War.
“Not tangible enough for legal application”?Footnote 23
In his landmark 2014 study on incidental mental harm in IHL, scholar Eliav Lieblich points to provisions in Geneva Convention IV codifying the protection of the person as a distinct value.Footnote 24 This turning point reflected “the emerging recognition at the time that damage to civilians … can transcend the strictly bodily”.Footnote 25 The next milestone for the protection of civilians from mental harm was reached with the adoption of Additional Protocol I to the Geneva Conventions in 1977. Article 51(2) in particular prohibits acts or threats of violence the primary purpose of which is to spread terror among the civilian population. The interpretation of other provisions as encompassing mental harm has been subject to some debate:Footnote 26 Article 35 prohibits the use of weapons causing superfluous injury and unnecessary suffering,Footnote 27 and Article 51(5)(b) prohibits attacks expected to cause civilian harm which would be excessive in relation to the anticipated military advantage (known as IHL’s proportionality principle).
Examining the hitherto ignored question of whether the proportionality calculus should include mental harm, Lieblich argues in favour of a teleological interpretation, concluding that “mental harm should be taken seriously, even when occurring incidentally, if IHL is to maintain its integrity as a coherent legal body”.Footnote 28 He does note that questions around causality, foreseeability and measurability require further discussion, and other scholars have built on his work since.Footnote 29 In this regard, the work of Solon Solomon stands out as a systematic effort to parse out state and judicial practice. In a series of five articles published since 2020, Solomon has argued forcefully in favour of the consideration of mental harm and has provided helpful suggestions on how to operationalize it.Footnote 30 Somewhat surprisingly, there are still very few articles looking at reparations for mental harm related to armed conflict in a specific context.Footnote 31
“The worst scars are in the mind”Footnote 32
Further research in the ICRC Library’s catalogue shows a similar evolution towards a recognition of harm both physical and mental in efforts to ban torture in international law. This culminated in the adoption of the 1984 Convention against Torture, which defines torture as any act by which severe pain or suffering, whether physical or mental, is intentionally inflicted for specific purposes. The year 1992 saw the publication of Torture and Its Consequences,Footnote 33 edited by Metin Başoğlu, which is still considered an influential reference in the field; several contributions to this volume examine the psychological and psychiatric consequences – including new knowledge on post-traumatic stress disorder – for survivors of torture. More recently, Hernán Reyes, a specialist on medical aspects of detention who worked for many years at the ICRC, published a contribution on psychological torture in the Review Footnote 34 where he stresses the difficulty of measuring mental pain and suffering to assess whether the severity criteria required by the Convention against Torture is met. Perhaps more poignant than arid legal reasoning, published testimonies of former detainees who were subjected to torture leave no doubt as to its lasting psychological effects, long after having been released from prison.Footnote 35
A wake-up call in the 1990s: The mental health of humanitarians
At the turn of the 1990s, concern for the mental health of humanitarians started to grow. Within the realm of our collections, the conversation opened with Raymond Saner’s Burnout Risks in the Humanitarian Work of Delegates of the ICRC, a paper presented at an international conference on psychological stress in 1989.Footnote 36 The tone is forthright and alarmed; Saner had interviewed ICRC delegates before and after missions, and in his paper he notes the inherently stressful and unpredictable nature of the job, the feelings of powerlessness, the sense of isolation and the erosion of belief systems, all of which fuelled the high burn-out rate he observed in delegates. In a final note, he expresses appreciation for comments from none other than the ICRC president, deputy director of operations and deputy chief of personnel. Institutional awareness of the issue was clearly emerging, and by 1994 it had led to the creation of a dedicated psychological support programme for delegates in the ICRC, run by psychiatrist Barthold Bierens de Haan and nurse Martine Bourquin.
A central figure and prolific writer, Bierens de Haan almost personified this field within our collections for a time. He authored numerous articles as well as two books, twenty years apart, detailing efforts to systematize mental health prevention and debriefings for ICRC staff members.Footnote 37 This flurry of publications was also a reaction to a backdrop of increasing violence against humanitarians in the 1990s. After the 1996 killings of six ICRC delegates in Novye Atagi, Bierens de Haan described carrying out debriefings with the survivors in the pages of the Review.Footnote 38
What Saner had called a “disregarded field”, the psychology of the humanitarian worker, found its way into professional debates and scientific literature. It is no coincidence that in the 2000s, the only purely medical journal to which the ICRC Library subscribed was the Revue francophone du stress et du trauma (Francophone Journal of Stress and Trauma). Browsing through the journal today, we are struck by a recurring refrain: each article opens by noting how mental health, in this or that context, is now being taken seriously at last. Progress, yes – but the repetition suggests resistance and stigma too.
“No alcohol or drugs, but someone to LISTEN”Footnote 39
In this context, one small publication stands out: the training brochure for ICRC delegates Humanitarian Action and Armed Conflict: Coping with Stress.Footnote 40 First published in 1994 and subsequently translated and re-edited multiple times, it aimed to put a diffuse form of suffering into words, explaining notions such as cumulative stress, traumatic stress and burn-out. It gave advice on how to manage emotional reactions and develop coping mechanisms, and proposed two practical anchors: the “three Rs” of rest, relief and relationships, and the “three Ts” of talk, tears and time. Breaking the silence, it insisted, was the most important. Testimonies by humanitarians in our collections show that their struggles have also remained unspoken or unheard.Footnote 41 The issue continues to draw attention: more recent scholarship, including works by ICRC health professionals, builds a growing evidence base on the mental health of humanitarians. Beyond recommendations addressed to the individual staff member, the literature increasingly emphasizes the responsibility of humanitarian organizations towards their staff.Footnote 42
In parallel, and particularly since the mid-2000s, advances in mental health research have led humanitarian organizations to professionalize their responses to the related needs of populations affected by armed conflict, structuring these efforts with dedicated programmes led by specialized staff. These initiatives are now well represented in our collections.
A growing collection: Systematizing, documenting and evaluating mental health care in armed conflict up to this day
The past twenty years have seen an evolution towards a more holistic and participatory approach to addressing mental health needs, in armed conflict and beyond. Mental health and psychosocial support, or MHPSS, has emerged as an umbrella term to bridge clinical approaches and social or community-based interventions. The field has professionalized and has become increasingly self-reflective, with the literature showing a growing emphasis on accountability and on the evaluation of MHPSS policies and programmes. In 2017, the ICRC published guidelines to harmonize projects addressing mental suffering across contexts, working with families and communities and respecting religious and cultural practices.Footnote 43 The ICRC’s MHPSS programmes are now twenty years old, and over the past five years they have increasingly become the object of studies in peer-reviewed journals.Footnote 44
The ICRC Library’s collections also hold books that are directly used in these programmes. After the conflicts in the former Yugoslavia, the ICRC prepared “books of the missing” and “books of belongings”.Footnote 45 Even though modern communication methods and DNA have changed how victims are identified, a book still carries particular symbolic value to honour a memory or to express suffering. In the 2010s, the ICRC delegation in Azerbaijan published a series of four books under the title Ölməzlik anları (Moments of Eternity),Footnote 46 bringing together stories, poems and illustrations about people who went missing during the Nagorno-Karabakh conflict, seen through their families’ eyes. As the 20th anniversary of the 1994 ceasefire came and went, the books also helped keep the unresolved issue of the missing, and the enduring pain of families, in the public eye. In 2025, it was through a cookbook born out of a partnership between the ICRC and the Movimento Nacional de Pessoas Desaparecidas (National Movement for Missing Persons) that family members of the disappeared in Brazil shared their pain and happy memories.Footnote 47 Finally, drawing on the Swedish Red Cross’s Birds in Flight programme, the ICRC’s MHPSS team has developed the Book about Me for children aged four to ten who have experienced conflict, torture or forced migration.Footnote 48 Children can paint, draw and write in its pages.
The growing attention and shift toward a better coordinated and evidence-based approach is a Movement-wide evolution. Mental health is not a new field of action for the Movement, but it has gained significant momentum and has become more clearly formalized over the past decade. Back in 1957, ahead of the 19th International Conference of the Red Cross and Red Crescent (International Conference), the Cuban delegation had first proposed a resolution to set up “a coordinating section or commission for the promotion of mental health work by the member societies”.Footnote 49 The Conference deemed the creation of a new body unnecessary, but it did not dismiss the issue completely, and it appealed to National Societies to intensify their activities in the field. Sixty years later, the Movement’s Council of Delegates adopted its first resolution on addressing mental health and psychosocial needs arising from armed conflicts, natural disasters and other emergencies.Footnote 50 Mental health was again a focus during the 2019 Statutory Meetings, with the adoption of the Movement’s first MHPSS policy at the Council of Delegates and a dedicated resolution calling upon both States and Movement components to step up their response at the International Conference.Footnote 51
To conclude, our collections show that the relief of mental suffering caused by armed conflict and other disasters is far from being a new concern. We could trace a continuous (if not perfectly straight) line from recent studies and guidelines back to the lists of deceased soldiers shared with families after nineteenth-century wars, and perhaps even back to Dunant’s Memory of Solferino. As understandings of mental health have evolved, the needs of different affected groups, from PoWs to families of the missing or humanitarians, have come into focus at different moments in time. Our collections show that mental health support was a humanitarian operational reality before mental health itself was ever construed as an individual right. It is certainly now time for legal scholars to catch up with developments in the medical and policy realms. We look forward to seeing the growth of a field of IHL that is still in its infancy, and to collecting on our shelves the evidence of stronger legal remedies for mental harm.
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